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Date run 12/26/2012 8:17:03A SAN Jl /UIN COUNTY ENVIRONMENTAL HEA {DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 12/26/2012 <br /> Record Selection Criteria: Facility ID FA0021537 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0011308 New Owner ID <br /> Owner Name SAN JOAQUIN REGIONAL RAIL COMM <br /> Owner DBA <br /> Owner Address 949 E CHANNEL ST <br /> STOCKTON, CA 95202 <br /> Home Phone 209-468-5600 <br /> Work/Business Phone 209-944-6220 <br /> Mailing Address 949 E CHANNEL ST <br /> STOCKTON, CA 952022620 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0021537 <br /> Facility Name SAN JOAQUIN REGIONAL RAIL COMM <br /> Location 1800 N MARSHALL AVE <br /> STOCKTON, CA 95205 <br /> Phone 209-944-6220 <br /> Mailing Address 949 E CHANNEL ST <br /> STOCKTON, CA 95202-2620 <br /> Care of <br /> Location Code 01 - STOCKTON Alt Phone <br /> BOS District 002 - RUHSTALLER, LARRY Fax <br /> APN 09416023 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name STACEY MORTENSEN <br /> Title EXECUTIVE DIRECTOR <br /> Day Phone 209-944-6220 <br /> Night Phone <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0038959 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name ANTEA GROUP (Circle One) <br /> Account Balance as of 12/26/2012: $-875.00 <br /> (Circle One) <br /> Transfer to Active/Inactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2950-ENVIRON ASSESS PR0537539 EE0001699-JOHNNY YOAKUM Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,anNor project specific,PHS/EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form I also certify that all operations will be performed in accordance with all applicable Ordinance Codes and/or Standards and State and/or <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Received by <br /> REHS: Date / / Account out: Date <br /> COMMENTS: <br />